Impact of Grass Surface Walking on Dynamic Balance in Individuals with Chronic Stroke

Abstract

Background: Impaired dynamic balance is a common consequence of chronic stroke, often limiting mobility and increasing fall risk. Traditional rehabilitation typically involves training on flat, stable surfaces, which may not adequately simulate real-world conditions. Incorporating walking on natural grass may offer a functional and effective way to enhance postural control and balance recovery. Aims: To evaluate the impact of grass surface walking program on improving dynamic balance in individuals with chronic stroke. Place and Duration of Study: Out-Patient Department, Kanishka Physiocare Physiotherapy Centre, Jaipur, between October 2024 and March 2025. Methodology: Study was conducted with 20 chronic stroke survivors, all were adults aged between 50-70 years, diagnosed with ischemic or hemorrhagic stroke at least six months before recruitment (chronic phase), ability to walk independently with or without assistive devices (Functional Ambulation Category ≥3), Mini-Mental State Examination (MMSE) score ≥24 (to ensure cognitive ability to follow instructions), and medically stable and cleared for physical activity by a physician. ‘Participants were divided equally into two groups’: the experimental group underwent a 4-week grass walking intervention, while the control group received routine physiotherapy. Dynamic balance was assessed pre- and post-intervention using the ‘Timed Up and Go (TUG) Test and the Dynamic Gait Index (DGI)’. Statistical analysis included ‘paired t-tests and group comparisons’, with significance set at ‘P < 0.05’. Results: This study included a total of 20 participants (10 in each group), with equal distribution of gender (5 males and 5 females per group). The mean age was comparable between groups — 62.5 years in the Grass Walking group and 62.7 years in the Control group. The grass walking group saw a notable decrease in TUG scores (mean reduction from 22.11s to 17.20s, P = 0.000) and a marked improvement in DGI scores (mean increase from 14.4 to 18.4, P = 0.000). In contrast, the control group exhibited minimal changes in both TUG and DGI, which, although statistically significant due to low variability, were not clinically meaningful. Conclusion: Walking on a natural grass surface significantly enhances ‘dynamic balance and functional gait’ in individuals with chronic stroke. Incorporating grass surface into rehabilitation programs may offer a cost-effective, practical, and functionally relevant strategy for improving post-stroke mobility outcomes.